Medicine and Health Sciences Commons^™

Implementation Of An Evidence-Based Intervention To Improve Human Papillomavirus (Hpv) Vaccination Rates Of Children Newly Admitted To A Residential Facility., Krista Danielle Fitzgerald

Doctor of Nursing Practice Papers

Background: The Centers for Disease Control and Prevention (CDC) estimates that more than 42 million Americans are presently infected with the Human Papillomavirus (HPV). The nurse practitioner (NP), who provided primary care to children at the residential facility, reported that only 60-70% of children were consented for HPV vaccination.

Purpose: The purpose of this evidence-based intervention was to have 90% of newly admitted children consented and vaccinated for HPV. The specific aims of this project were to (1) increase staff HPV/HPV vaccine knowledge, (2) implement an updated evidence-based consent form, and (3) increase the HPV consent and vaccination rates.

Methods: …

A Bundle Of Care For Prevention, Early Recognition, And Treatment Of Hyaluronic Acid Dermal Filler Associated Vascular Occlusion, Genny Sanders

Doctor of Nursing Practice Papers

Background: Hyaluronic acid (HA) dermal fillers, an injectable used for cosmetic use, are gaining popularity, and are expected to continue to do so in the projected future. With the rise in the number of patients seeking these procedures there is a correlated rise is adverse events, including the complication of vascular occlusion. Vascular occlusion has the potential for detrimental outcomes, and clinicians performing these procedures are responsible for educating patients about these risks. As whole, the healthcare community must be prepared.

Purpose: A quality improvement (QI) project was created to help clinicians prepare, prevent, recognize, and treat hyaluronic acid dermal …

Evaluation Of An Educational Training On Telehelath Utilization Rates And Hospital Readmissions In A Home Health Setting., Gabrielle A. Coomer

Doctor of Nursing Practice Papers

Background: Hospital readmissions are on the rise and continue to be a concern within healthcare due to their effects on the quality of care and healthcare costs. Telehealth strategies have been utilized across healthcare settings to improve hospital readmission rates.

Purpose: The purpose of this project was to evaluate the effectiveness of a telehealth training program in increasing telehealth utilization rates and reducing the acute care hospitalization rate within a single home health agency.

Intervention: A 30-minute PowerPoint presentation on the definition of telehealth, goals, and benefits of telehealth, patient eligibility, special considerations for clinicians, billing and coding guidelines, …

Improving Transitions In Care Through Early Discharge Planning: A Quality Improvement Initiative., Sarah Markgraf

Doctor of Nursing Practice Papers

Background: A substantial body of evidence has shown transitions in care are one of the weakest links in healthcare networks, especially for older adults with complex comorbidities. Residents receiving short-term rehabilitation (i.e., rehab) transitioning to home from a skilled nursing facility (SNF) are the most vulnerable in the first 30 days post-discharge for adverse resident events, including avoidable rehospitalization. Avoidable rehospitalizations cost Medicare billions of dollars annually and lead to poor resident outcomes. Early discharge planning in SNFs for short-term stay rehabilitation has decreased rates of avoidable rehospitalizations, improved quality of life in geriatric residents, and improved care partners' perceived …

Improving Pressure Injury Nurse Awareness And Decision-Making In The Cardiac Intensive Care Unit: A Quality Improvement Project., Sarah G. Moreno

Doctor of Nursing Practice Papers

Abstract

Background/Significance: Hospitalized patients with pressure injuries have 5 times greater death compared to a patient without a pressure injury. A needs assessment identified the problem of pressure injuries in the CVICU with the goal to improve nurse awareness and decision-making to decrease pressure injuries in the CVICU.

Purpose: The purpose of this project was to increase nurse awareness of pressure injury prevention via an education workshop and evidence-based pressure injury decision tree in the Cardiovascular ICU.

Methods: A MeSH search was conducted to identify pressure injury interventions and nurse awareness of pressure injuries which resulted in 17 …

Reducing Stress And Improving Mindfulness Practices Among Mental Health Professionals Through Guided Meditation., Liara G. Patton

Doctor of Nursing Practice Papers

Abstract

Background: Chronic exposure to psychological stress places mental health providers in a vulnerable position when coping skills are not learned or available. Mental health providers are at risk for both mental and physical illness due to the empathetic demands of their client’s stressors. The deficit in adequate coping skills can cause provider-client relationships to suffer and create an undesirable work environment.

Setting: This project took place in Somerset, KY, at a mental health company called A New Beginnings Achievement Center (ANBAC). Twenty-six employees work at ANBAC, all of whom are involved in providing mental health services to developmentally delayed …

Lgbt Cultural Competence Education For Nurse Leaders In A Large Metropolitan Healthcare System: Quality Improvement, Trevor Mcguffin, Andrew Mitchell

Doctor of Nursing Practice Papers

Background: In the United States, seven percent of adults identify as LGBT. The LGBT population is disproportionately affected by health disparities and barriers to care when compared to the cis-heterosexual population. Due to healthcare providers’ limited LGBT health education and experience, inconsistencies in LGBT culturally competent care perpetuate health disparities and barriers to care for the LGBT population.

Purpose: The purpose of this quality improvement project was to educate nurse leaders on LGBT cultural competency and facilitate nurse leaders’ behavior change.

Methods: This quality improvement project consisted of three LGBT cultural competence modules and two guided behavior change pathways. Outcomes …

Improving Treatment And Follow-Up Care For Patients Who Screen Positive For Depression In Family Practice: A Quality Improvement Project., Jennifer D. Hooper

Doctor of Nursing Practice Papers

Background: Depression is a prevalent condition requiring systematic approaches for effective treatment and follow-up in primary care. This quality improvement project aimed to enhance care for patients screening positive for depression at an academic family practice with a diverse patient population and a comprehensive electronic health record (EHR) system.

Purpose: The primary objective was to assess whether a provider educational session and the implementation of an optional depression treatment and follow-up algorithm could improve timely and appropriate care for patients with positive PHQ-9 screenings.

Setting: The project was conducted at an academic family practice office.

Methods/Procedures: The intervention included a …

Promoting Healthy Habits Among Children In A Residential Facility., Tiffany Jones

Doctor of Nursing Practice Papers

Background: Childhood obesity has been a significant public health concern in the United States. The prevalence of obesity among children and adolescents has increased over the past few decades. There are serious implications for immediate and long-term health. It poses serious health risks and economic challenges.

Setting: This quality improvement project will take place at a residential psychiatric treatment facility and therapeutic foster care program for children and adolescents with mental health or behavioral issues. This facility is in the suburbs of Louisville, Kentucky.

Purpose: The purpose of this project is to boost physical activity and improve knowledge about nutrition …

Addressing Caregiver Burden Among Oncology Caregivers: An Educational Intervention., Alexandria Salois

Doctor of Nursing Practice Papers

The incidence of cancer is on the rise, the number of cancer diagnoses are increasing at an alarming rate with advanced technologies and available evidence. Cancer care has also shifted from the inpatient setting to mostly outpatient. With this, a large portion of the responsibility has been transferred to the caregiver of that patient (Kent et al., 2019). Historically, caregivers have not been at the forefront of research, however, the concept of caregiver burden is beginning to emerge. A gap exists in addressing the needs of caregivers in both evidence-based data and with the local community cancer support group, Gilda’s …

Daily Alarm Rounds: Enhancing Interdisciplinary Communication And Reducing Perceived Alarm Burden In Bedside Nurses., Shelby Mangeot

Doctor of Nursing Practice Papers

Purpose: The Joint Commission established alarm management as a national patient safety goal in 2013 and has continued this goal through 2023 (2022). This goal mandates hospitals to prioritize alarm system management and establish evidence-based techniques to manage and reduce nuisance alarms. The purpose of this quality improvement project was to provide bedside nurses with education about excessive alarm burden and evidence-based alarm management techniques, then implement a daily bedside alarm rounding tool to enhance interdisciplinary communication and address patient alarm limits during daily rounds.

Methods: After extensive review of the literature, prompts discussing daily alarm limits were added to …

Improving The Integration Of Whole Health Into A Veterans Affairs Outpatient Primary Care Clinic., Diana Lynn Blair

Doctor of Nursing Practice Papers

Abstract

The annual $4.1 trillion price tag for healthcare with a simultaneous decline in patient health outcomes is the catalyst to change the current healthcare culture from disease-focused to a Whole Health wellness and prevention model. Transforming to preventative care would remedy the current costly healthcare system, thus Veterans Health Administration (VHA) set forth a mandate to implement Whole Health (WH) system wide. The purpose of this project was to provide a training program that facilitated the implementation of WH and improve the documentation of WH in the electronic health record (EHR). A needs assessment provided to the Fort Knox …

Evaluation And Implementation Of Mindfulness Module To Reduce Burnout Among Emergency Department Nurses: A Quality Improvement Project, Katie Waltrip

Doctor of Nursing Practice Papers

BACKGROUND: Nurses working in the ED experience higher burnout rates than those working in other healthcare settings. Defined as emotional exhaustion, depersonalization, and a low sense of personal accomplishment, burnout is associated with increased work absences and turnover and decreased patient satisfaction and quality care. Burnout must be examined and addressed for emergency nurses to continue providing quality care.

PURPOSE: This quality improvement project aimed to evaluate burnout among nurses working in the ED prior to and immediately following a 9-week mindfulness-based intervention.

METHODS: A Plan-Do-Study-Act model was utilized along with application of supporting evidence from the literature and an …

A Parenting-Skills Intervention To Mitigate Adverse Childhood Experiences For Children Of Parents In Substance Use Disorder Recovery., Makayla S. Haas

Doctor of Nursing Practice Papers

Abstract

Background: Parents recovering from substance use disorder (SUD) are prone to neurobiological alterations that affect parental emotional regulation, increasing occurrence of harsh parenting, heightened stress, and relapse. Children with parents who suffer from SUD experience adverse childhood experiences (ACE), predisposing them to negative health and lifestyle risks. Implementing a parenting-skills intervention for parents in recovery can promote positive-parenting, reduce parenting stress, improve the parent-child relationship, and mitigate the effects of ACEs.

Setting: ChooseWell Communities (CWC), a sober-living community, in Louisville, KY served as the project site. Participants at CWC are sober parents with primarily young children under 5 years …

Implementation Of A Crna Clinical Faculty Preceptorship Workshop: A Quality Improvement Project., Sarah Veeneman

Doctor of Nursing Practice Papers

Background/Significance: Certified Registered Nurse Anesthetists (CRNAs) undergo extensive didactic and clinical training when earning their doctoral practice degrees. However, there is inconsistency of preceptor clinical training.

Purpose: The purpose of this quality improvement project was to improve the consistency in preparedness of CRNA clinical faculty preceptors who train nurse anesthesia residents (NARs).

Methods: A pre-post approach was used. A MeSH search was conducted that resulted in 13 studies that were examined for quality and applicability for this project. The Plan-Do-Study-Act model was the framework to guide this quality improvement project.

Intervention: Participants attended one 3-hour educational training workshop. …

Focused Interventions To Decrease Inpatient Falls, Alyssa Nicole Watchmaker Smith

Doctor of Nursing Practice Papers

Background: Falls are the most commonly reported safety incidence in the hospital setting (Morris R. et al., 2017). Because falls may be a result of many factors, evidence shows that multicomponent fall interventions best reduce fall rates (Bargmann et al., 2020; Dykes et al., 2010; Dykes et al., 2020; Strini et al., 2021). In this project, a needs assessment identified a need for fall prevention strategies to reduce fall rates on inpatient units.

Setting: A step-down/telemetry Cardiovascular Intervention Unit (CVI) (15 beds) and Cardiovascular Unit (CVU) (12 beds) in a suburban private hospital.

Purpose: The purpose of this evidence-based project …

Implementation Of A Mindfulness Approach To Emotional Regulation In A Public High School., Kaelin Cherise Shay

Doctor of Nursing Practice Papers

According to the Gallup and Walton Family Foundation-State of American Youth Survey for 2023, schools in the United States received an average grade of C+ when it comes to supporting their students’ mental health, highlighting a potential area for improvement in the school system (Wilcoxon & Marken, 2023). This quality improvement project aimed to teach high school students about emotional regulation using a mindfulness platform and evidence-based techniques designed for the school environment. The sessions focused on improving the students’ understanding of emotions and emotional regulation and helping them apply techniques to regulate emotions in a healthy manner.

This project …

Restorative Yoga To Increase Mindfulness And Reduce Anxiety And Burnout Of Inpatient Mental Health Workers: A Quality Improvement Project, Rachaele Warden

Doctor of Nursing Practice Papers

Background/Significance: Burnout syndrome negatively impacts healthcare systems via quality reduction of patient care and communication, increased medical errors, hospital-acquired infections, staffing shortages, and costly malpractice suits (De Hert, 2020). The characteristic exhaustion, cynicism, job detachment, feelings of inadequacy and incompetence that emerge from burnout further hinder individual mental health and wellbeing.

Purpose: The purpose of the restorative yoga intervention strives to reduce employee anxiety, burnout and enhance mindfulness-based practice strategies within a local inpatient mental health hospital.

Methods: Quality improvement project with evidence-based interventions.

Interventions: The project intends to hold one instructor-guided and one video-guided 25-minute restorative yoga weekly session …

Modifiers Of The Effects Of Different Dimensions Of Social Support On Cardiac Rehabilitation Adherence., Melissa Amraotkar

Electronic Theses and Dissertations

Introduction: Cardiovascular disease (CVD) is a leading cause of mortality worldwide. Cardiac Rehabilitation (CR) is a Class I, level A indication for treatment and prevention further complications of CVD. The attendance rate for CR in the U.S. is very low, especially among female patients. Dimensions of social support, sex of the support provider, and the quality of primary intimate relationship are associated with health-promoting behavior and may influence CR adherence in patients. Purpose: The purpose of this study was to examine the relationship between dimensions of social support and CR adherence, and whether these relationships were moderated by factors such …

Acute Mechanical Circulatory Support In The Cardiovascular Icu: Investigating The Effects Of An Interactive Cardiovascular Dynamics Simulation Program On Nursing Clinical Judgment., Casey Saulman

Electronic Theses and Dissertations

Introduction: Education on acute mechanical circulatory support (AMCS), a therapy used in the cardiovascular intensive care unit (CICU) to manage cardiogenic shock (CGS) is limited for CICU nurses. There is a need to explore clinical judgment in CICU nurses and provide innovative learning experiences that foster judgment when managing AMCS. Methods: This mixed methods feasibility study investigated the effects of an interactive cardiovascular dynamics simulation program on CICU nurses’ knowledge, clinical reasoning, and clinical judgment. Semi-structured interviews explored the participants’ perceptions of the learning experience. Results: Twenty-one nurses completed the cardiovascular dynamics simulation program. The majority were white (85.7%), female …

A Conceptual Model Of Organizational Compassion In Healthcare, Rachel Thienprayoon, Eli Awtrey, Teresa Pestian, Beth A. Lown, Naomi Winick, Jason Kanov

Journal of Wellness

Introduction: In healthcare, while the suffering of patients is often evident, the suffering of clinicians receives less focus. Some sources of clinician distress are directly related to constant exposure to patient suffering, but others are caused by the health care system, and thus potentially preventable. Looking at clinician suffering through the lens of compassion fosters a new paradigm of individual, team, and organizational capabilities, and moves the responsibility to alleviate this suffering from the individual onto the organization and team. Yet research into the impact of organizational compassion in healthcare has been extremely limited.

Approach: Our conceptual model of organizational …

Innovative Virtual Wellness Interventions At An Academic Medical Center: A Pilot Feasibility Study, Ritika Baweja, Michael Hayes, Aditya Joshi, Raman Baweja

Journal of Wellness

Introduction: There is generally a concerning likelihood of burnout in healthcare workers. Given the impact of COVID-19 on healthcare workers, our institution identified the need for wellness interventions to foster adaptive functioning and mitigate burnout. The purpose of this pilot project was to assess the feasibility of virtual holistic interventions like meditation, art, laughter therapy and dance and their impact on overall well-being of physicians and advanced practice providers (APPs).

Methods: A series of 12 virtual sessions (art therapy, dance therapy, mindfulness-based practices/meditation and laughter therapy) were offered to providers over a 6-month period. Participants completed an online survey reporting …

Wellness Review 2023, Part 1, Brian A. Ferguson, Martin Huecker

Journal of Wellness

Introduction: The 2023 Part 1 summary reviews research on wellness in healthcare professionals published outside of JWellness from January 1, 2023 to June 30, 2023.

Methods: Editors conducted a Boolean search of titles and abstracts in PubMed utilizing keyword identifiers pairing healthcare personnel (providers, nurses, and other staff) with a well-being metric. Of 416 relevant articles, an intriguing and innovative 30 were selected for inclusion, with two additional articles manually curated.

Literature in Review: This sample of the recent literature into healthcare professional wellness included multiple targeted interventions and studies of resilience. Main themes that emerged include: positive systematic healthcare …

Recommendation Of Intermittent Fasting In The Treatment Of Chronic Musculoskeletal Pain: Evaluating Healthcare Provider Behavior And Patient Fasting Behavior., Melissa Humphreys, Melissa Humphreys

Doctor of Nursing Practice Papers

Abstract

Background: Chronic musculoskeletal pain was a significant problem in this primary care clinic. A total of 75% of the primary care providers (PCPs) agreed to consider an alternative treatment for chronic pain and Intermittent fasting (IF) was introduced as an option.

Purpose: Quality improvement project to introduce IF as an adjunct to traditional pain management for chronic musculoskeletal pain, evaluate PCPs’ application, and patient response to provider recommendation of IF.

Methods: A virtual continuing education (CE) program on IF was presented to PCPs in family medicine to establish baseline competency. For two months, 29 patients were recommended IF who …

Utilization Of Wellness Practices For Burnout And Stress During Covid-19 Among An Interdisciplinary Cohort Of Emergency Healthcare Workers, Michael J. Zdradzinski, Sheri-Ann O. Kaltiso, Roslyn Seitz, Timothy P. Moran, Jennifer Clements, Sheryl L. Heron, Michelle D. Lall

Journal of Wellness

Introduction: The Coronavirus Disease (COVID-19) introduced additional stress to the baseline occupational stressors of emergency care workers. The objectives of this study were to evaluate perceived stress and burnout and the utilization and perceived benefit of wellness practices among emergency healthcare workers (EHCWs), including: emergency physicians, advanced practice providers (APPs), nurses, and departmental administrative staff during the COVID-19 pandemic.

Methods: A cross-sectional 28-item electronic survey of EHCWs at three hospitals in a major United States city was used to measure participants’ utilization and perceived benefit of wellness practices, burnout (2-item measure), overall stress (perceived stress scale), and stress …

Use Of Electronic Health Record Reminders To Improve Primary Care Providers’ Colorectal Cancer Screening Recommendations., Terra Renee Schrembs

Doctor of Nursing Practice Papers

Background: Colorectal cancer (CRC) is the third most common worldwide cause of cancer morbidity and mortality. CRC mortality is preventable through regular screening. Electronic health record (EHR) reminders for providers can increase providers’ CRC screening recommendations and lead to earlier CRC diagnosis. According to the National Cancer Institute’s Screening and Risk Factors Report for Kentucky by County 2008-2010, 62.7% of adults in a rural Kentucky county aged 50-75 had completed a home based FOBT in the past two years or have ever had a colorectal endoscopy.

Purpose: The purpose of this DNP project was to implement and evaluate an …

Evaluation Of Sensory Room Education To Promote Usage In An Inpatient Psychiatric Setting: A Quality Improvement Project., Breanna M. Coulardot

Doctor of Nursing Practice Papers

Seclusion and restraints are intended to be used as a last resort intervention if a patient presents as harmful to themself or others. However, the use of seclusion and restraints in mental health practice has been questioned for several decades. A 26-year study that researched restraint-related fatalities among children and adolescents in the United States from 1993 to 2018 disclosed 79 deaths (Nunno et al., 2022). Seclusion and restraints also restrict autonomy which can cause retraumatization if a patient was previously neglected or abused (Hammer et al., 2011). Many patients presenting to the project site are survivors of neglect and …

Enhancing Adherence To Best Practice Guidelines Related To Pressure Injury Prevention In The Operating Room At A Children's Hospital During Comprehensive Dental Procedures., Alyce Bailey Seaver

Doctor of Nursing Practice Papers

Background: 1,600,000 patients develop a hospital-acquired pressure injury every year, and 23% of these originate during surgery. Research has demonstrated that the incidence of hospital-acquired pressure injuries developing during surgery has risen over the past 5 years. This rise has been attributed to nurse circulators exhibiting poor knowledge regarding best practices for intraoperative patient positioning and intraoperative documentation that does not follow standards of care.

Purpose: This quality improvement project aimed to enhance circulator knowledge on best practices for intraoperative patient positioning and improve documentation of intraoperative patient positioning in the electronic medical record to comply with standards of …

Improving Central Line-Associated Bloodstream Infection Prevention Bundle Compliance To Reduce Infection Rates In A Pediatric Cardiac Intensive Care Unit., Aubree Croghan

Doctor of Nursing Practice Papers

Background: Central line-associated bloodstream infection (CLABSI) is the most common healthcare-acquired infection in pediatrics. A pediatric acute care facility in Kentucky created a specialized care team in an effort to track CLABSI bundle compliance and reduce central line infections. While rates of infection decreased, a significant number of infections still occurred and staff adherence to facility evidence-based policies and infection prevention interventions remained low.

Purpose: To reach the facility’s goal of zero central line-associated bloodstream infections, a quality improvement (QI) project was developed to improve staff knowledge of care and increase staff adherence to policy.

Methodology: To create the QI …

A Program Evaluation Of Domestic Violence Screening At A Large Urban Hospital., Taylor L'Heureux

Doctor of Nursing Practice Papers

Domestic violence has been deemed a direct invasion and violation of human rights by the World Health Organization (2021). Due to the continuous rise in cases of domestic violence, national organizations like the United States Preventative Services Task Force (USPSTF) have recommended that healthcare providers screen patients for this abuse. The purpose of this study was to reinforce the current screening procedure and protocol to ensure that each patient was screened for domestic violence before being discharged from the hospital. This study evaluated a quality improvement project formed to promote the completion of a preexisting domestic violence screening form that …